Four years ago, City Controller Alan Butkovitz released a report revealing a Philadelphia EMS system in crisis: Sick people waiting too long for ambulances; paramedics dangerously overworked; and non-emergency calls overwhelming the system.

The report echoed the pleas of paramedics who had long called for change, and recommended steps to relieve pressure on the stressed 911 system.

Four years later, little has changed, Butkovitz said Wednesday as he released a follow-up audit that analyzed Fire Department data from 2009.